Doctors' positioning of defibrillation paddles

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Defibrillation paddle positioning. Intervention: Defibrillation paddle placement.

J Calinas-Correia

doi:10.1136/bmj.323.7320.1065

November 3, 2001BMJ

Doctors' positioning of defibrillation paddles

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Key result

Defibrillation paddle placement guidelines rely on outdated evidence with unproven clinical relevance.

Why the study?

A previous observational study assessed doctors performance in placing defibrillation paddles on a training manikin without evaluating the level of evidence supporting correct paddle placement.

Key Points

To critically appraise the scientific evidence base establishing what constitutes correct defibrillator paddle positioning in clinical resuscitation guidelines.
Critical appraisal of literature and clinical guidance from resuscitation councils defining recommended paddle placement standards.
Evaluation of foundational studies regarding differences in equipment, shock waveforms, and clinical indications such as elective cardioversion.
Identified that guideline definitions of correct paddle positioning rest primarily on two historical studies from 1967 and 1981.
Found that foundational evidence involved obsolete equipment, differing shock waveforms, or elective cardioversion of atrial fibrillation rather than acute cardiac arrest.
Concluded that existing published literature provides no direct evidence that minor variations in paddle placement produce meaningful differences in clinical outcomes.

PICO

P

Population

Defibrillation paddle positioning

I

Intervention / Comparator

Defibrillation paddle placement

Limitations

Guidelines on correct paddle placement rely on only two references from 1967 and 1981
The 1967 work used different equipment, timings between shocks, and waveforms
The 1981 study exclusively addressed the elective cardioversion of atrial fibrillation

Implication

Defibrillation paddle guidelines lack robust modern support; observational data leaves open whether positional variations affect outcomes.

Abstract

# Level of evidence should have been assessed {#article-title-2} EDITOR—Heames et al assessed the performance of doctors in placing defibrillation paddles in the correct positions on the chest of a training manikin.1 They forgot to assess the level of evidence that allows for the determination of correct placement. Volume 46 of Resuscitation presents only two references about paddle placement: one is the original work by Lown in 1967, the other a 1981 study by Kerber et al.2–4 The text in Resuscitation is almost word for word that of the American Heart Association's guidelines published in 1992 in the journal of the American Medical Association, which offered the same paucity of references.5 I conclude that the evidence on which Heames et al base their assessment is the original work done in 1967 and the comparison made by Kerber et al. The work in 1967 was done with quite different equipment, timings between shocks, and wave forms. The comparison by Kerber et al was between anterolateral and anteroposterior placement, with only one version of either except for the pad's diameter, and exclusively addressed the cardioversion of atrial fibrillation. So far as the references quoted go, there is no evidence that the variation detected by the study is of any clinical importance. 1. 1.↵1. Heames RM, 2. Sado D, 3. Deakin CD .Do doctors position defibrillator paddles correctly? Observational study.BMJ2001;322: 1393–1394. (9 June.) [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Part 4: the automated external defibrillator: key link in the chain of survival .Resuscitation2000;46:73–91. [OpenUrl][3][CrossRef][4][PubMed][5] 3. 3.1. Part 6: advanced cardiovascular life support .Section 2: defibrillation.Resuscitation2000;46:109–113. [OpenUrl][6][CrossRef][7][PubMed][8] 4. 4.↵1. Kerber RE, 2. Jensen SR, 3. Grayzel J, 4. Kennedy J, 5. Hoyt R .Elective cardioversion: influence of paddle-electrode location and size on success rates and energy requirementsN Engl J Med1981;305:658–662. [OpenUrl][9][PubMed][10][Web of Science][11] 5. 5.↵1. Emergency Cardiac Care Committee and Subcommittees, American Heart Association .Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Part IX. Ensuring effectiveness of communitywide emergency cardiac care.JAMA1992;268:2289–2295. [OpenUrl][12][CrossRef][13][PubMed][14] # Other factors have not been assessed {#article-title-7} EDITOR—Heames et al report a study of 101 doctors who were asked … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DHeames%26rft.auinit1%253DR.%2BM%26rft.volume%253D322%26rft.issue%253D7299%26rft.spage%253D1393%26rft.epage%253D1394%26rft.atitle%253DDo%2Bdoctors%2Bposition%2Bdefibrillation%2Bpaddles%2Bcorrectly%253F%2BObservational%2Bstudy%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.322.7299.1393%26rft_id%253Dinfo%253Apmid%252F11397743%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=322/7299/1393&atom=%2Fbmj%2F323%2F7320%2F1065.atom [3]: {openurl}?query=rft.jtitle%253DResuscitation%26rft.stitle%253DResuscitation%26rft.volume%253D46%26rft.issue%253D1-3%26rft.spage%253D73%26rft.epage%253D91%26rft.atitle%253DPart%2B4%253A%2Bthe%2Bautomated%2Bexternal%2Bdefibrillator%253A%2Bkey%2Blink%2Bin%2Bthe%2Bchain%2Bof%2Bsurvival.%2BEuropean%2BResuscitation%2BCouncil.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0300-9572%252800%252900272-0%26rft_id%253Dinfo%253Apmid%252F10978789%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1016/S0300-9572(00)00272-0&link_type=DOI [5]: /lookup/external-ref?access_num=10978789&link_type=MED&atom=%2Fbmj%2F323%2F7320%2F1065.atom [6]: {openurl}?query=rft.jtitle%253DResuscitation%26rft.stitle%253DResuscitation%26rft.volume%253D46%26rft.issue%253D1-3%26rft.spage%253D109%26rft.epage%253D113%26rft.atitle%253DPart%2B6%253A%2Badvanced%2Bcardiovascular%2Blife%2Bsupport.%2BSection%2B2%253A%2Bdefibrillation.%2BEuropean%2BResuscitation%2BCouncil.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0300-9572%252800%252900275-6%26rft_id%253Dinfo%253Apmid%252F10978792%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/external-ref?access_num=10.1016/S0300-9572(00)00275-6&link_type=DOI [8]: /lookup/external-ref?access_num=10978792&link_type=MED&atom=%2Fbmj%2F323%2F7320%2F1065.atom [9]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DKerber%26rft.auinit1%253DR.%2BE.%26rft.volume%253D305%26rft.issue%253D12%26rft.spage%253D658%26rft.epage%253D662%26rft.atitle%253DElective%2Bcardioversion%253A%2Binfluence%2Bof%2Bpaddle-electrode%2Blocation%2Band%2Bsize%2Bon%2Bsuccess%2Brates%2Band%2Benergy%2Brequirements%26rft_id%253Dinfo%253Apmid%252F7266602%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [10]: /lookup/external-ref?access_num=7266602&link_type=MED&atom=%2Fbmj%2F323%2F7320%2F1065.atom [11]: /lookup/external-ref?access_num=A1981MF33900002&link_type=ISI [12]: {openurl}?query=rft.jtitle%253DJAMA%26rft.stitle%253DJAMA%26rft.issn%253D0002-9955%26rft.volume%253D268%26rft.issue%253D16%26rft.spage%253D2289%26rft.epage%253D2295%26rft.atitle%253DEnsuring%2BEffectiveness%2Bof%2BCommunitywide%2BEmergency%2BCardiac%2BCare%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjama.1992.03490160159032%26rft_id%253Dinfo%253Apmid%252F1404775%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [13]: /lookup/external-ref?access_num=10.1001/jama.1992.03490160159032&link_type=DOI [14]: /lookup/external-ref?access_num=1404775&link_type=MED&atom=%2Fbmj%2F323%2F7320%2F1065.atom

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Cite This Study

J Calinas-Correia (2001) conducted a letter in Defibrillation paddle positioning. Defibrillation paddle placement was evaluated. Defibrillation paddle placement guidelines rely on 1967 and 1981 studies with no evidence that positional variations reported in 101 doctors are clinically important.

synapsesocial.com/papers/6ae0e4712183b01806bd6f6d https://doi.org/10.1136/bmj.323.7320.1065

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Doctors' positioning of defibrillation paddles

Key Points

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Doctors' positioning of defibrillation paddles

Key Points

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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